Distribution of hepatitis C virus genotypes in haemodialysis patients of Guilan, northern Islamic Republic of Iran

The incidence of hepatitis C virus [HCV] infection among patients undergoing haemodialysis is high. The aim of this study was to identify the HCV genotypes among chronic haemodialysis patients who were HCV positive in Guilan province, northern Islamic Republic of Iran. All patients on haemodialysis at Guilan haemodialysis centres were enrolled. Enzyme-linked immunosorbent assay and polymerase chain reaction testing were performed. Out of 514 enrolled patients, 11.9% were serologically HCV positive and 6.2% had positive HCV-RNA. HCV genotypes were determined with HCV genotype-specific primers. The most frequent genotypes were la [59.4%] and 3a [40.6%]. There was no significant relationship between virus genotypes and sex or age. The HCV genotype pattern among haemodialysis patients in Guilan province was different from other countries of the Middle East and was more similar to North American and European countries where genotype 1 is predominant

[Survey the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction]

The liver played an important role in the metabolism of thyroid hormones and was involved in their conjugation, excretion and peripheral deiodination in synthesizing Thyroid Binding Globulin [TBG]. Thus liver dysfunction can be influenced thyroid function. Determine the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction. Sixty Four Cirrhotic patients due to hepatitis B and C referring to Razi hospital were studied during 2007-2009 years. Data were collected by prepared questionnaire. Thyroid hormone levels were measured in a unit laboratory. Liver dysfunction was scored by MELD and child pugh scoring systems. Mann-Whitney U, chi square and kruskal wallis test were used for measuring severity of liver dysfunction. Among 64 patients, [42 patients were male and 22 patients were female]. Mean age of patients was 55.03 +/- 12.05. Level of TT3 TT4 and FT3 had decreased in the majority of patients, TT3, TT4 and FT3 levels. There was a correlation between level of TT3 and severity of liver dysfunction base on Child score [p=0.0001] and MELD [p=0.02].There was a reciprocal correlation between TT3 level and probability of the history of digestive systems bleedings, Ascites and encephalopathy [P=0.01, P=0.011, P=0.009] .It means that when TT3 level was low probability of this complication was high. This study showed that liver disease is accompanied by changes in thyroid hormone levels specially decrease the level of TT3, TT4, FT3 and it is indicated that TT3 level can be used as liver function index in cirrhotic patients due to hepatitis B and C

[Anxiety-depressive disorders among irritable bowel syndrome [IBS] patients]

Psychiatric disorders are common in Irritable Bowel Syndrome [IBS] patients. Prevalence of psychiatric disorders varies in IBS patients in different societies. To determine the prevalence of psychiatric disorders [anxiety-depression] in IBS patients in Rasht. In this cross-sectional study, 256 IBS patients were selected [using criteria of Rome III] and evaluated for psychiatric disorders. In the first phase, subjects were screened by GHQ28. In the second phase, those patients who had scores equal or more than 23 were assessed through semi-structured psychiatric interview. Socio-demographic variables including age, gender, marital status, educational level and occupation, were recorded as well. P-values less than 0.05 were considered statistically significant. Among 256 subjects 30 patients [11.7%] had no significant psychiatric symptoms and 226 subjects [83 male, 143 female] suffered from some degrees of psychiatric problems. After performing semi-structured psychiatric interview; 190 subjects [74.2%] had anxiety-depressive problems [89 patients were suffered from pure anxiety disorders, 41 patients suffered from depressive disorders and 60 patients had co-morbid anxiety-depressive disorders]. In anxiety disorders; generalized anxiety disorder [53.7%] and in depressive disorders; dysthymia [53.5%] had the most frequencies, 53.7% and 53.5% respectively. In comparisone of anxiety-depressive subjects [190 persons] and normal subjects [66 persons], there was a significant statistical differences between the gender [P=0.019], occupation [P=0.002] and intensity of IBS [P<0.001]. Although, further studies are needed to determine the relations of demographic variables and types of IBS with psychiatric disorders, it seems to more attention to the psychiatric disorders of some specific patients suffering from IBS is helpful to their treatment

Assessment of propofol usefulness as an anesthetic agent during colonoscopy

Propofol is used as a sedative drug during colonoscopy. In this study we analyzed the adverse effects of propofol [i.e., hemodynamic and respiratory] on patients who underwent colonoscopies. This study was performed in Qom Province, Iran. In this study, 125 patients [63 females, 62 males] were enrolled. Study patients were administered [0.5-1.5 mg/kg] intravenous propofol by and anesthesiologist. Oxygen saturation and blood pressure were recorded at three minute intervals. We used the American Society of Anesthesiology [ASA] classification to stratify patients by risk prior to the procedure. For statistical analysis, the chi-square and paired t-tests were used. A p-value less than 0.05 was considered significant. Patients' mean age was 45.36 +/- 16.19 years. ASA-I comprised 25.6% of study patients and 74.4% were categorized as ASA-II. Hypopnea occurred in 56.8% of patients and was prolonged in 32.4%. Of the study patients, 5.6% developed hypoxemia which was successfully controlled by the administration of nasal oxygen and no need for mechanical ventilation. The mean arterial blood pressure [p< 0.0001], oxygen saturation [p< 0.0001] and heart rate [p<0.0001] significantly decreased during colonoscopy. The occurrence of hypopnea significantly increased in patients with pre-procedure oxygen saturation levels /= 50 years [p< 0.0001] and ASA class II [p<0.0001] Agitation, hypotension and cough were seen in 1.6%, 1.6% and 0.8% of patients, respectively. Propofol has a short half life that enables faster recovery of normal neurologic and social functions we recommend the use of propofol under supervision of anesthesiologist or a trained gastroenterologist

Clinical manifestations of Hirschsprung's disease: a six year course review of admitted patients in Gilan, northern Iran

Hirschsprung's disease [HD] is a congenital disease in which intestinal ganglionic cells are absent, leading to intestinal obstruction. The disease has various clinical manifestations and different lengths of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a six year course study in Gilan, a northern province of Iran. We studied patients diagnosed with HD who were referred to the Gilan Surgery Referral Center in Poursina Hospital from 1995 until 2001. In this cross sectional descriptive-analytical study, all data were collected from patients' files and questionnaires. Data included demographics, clinical presentations, diagnostic methods, involved intestinal segments, type of surgical procedure, and surgical complications. There were 58 cases of HD during this six year period that underwent surgery. Of these, 19 patients were female and 39 were male whose ages ranged from one day to 18 years old. A variety of clinical findings such as: constipation, abdominal distension, failure to pass meconium, diarrhea, and other less common manifestations were present. We found three different pathological types: rectosigmoid, ultra short segment and total colonic involved segment. No differences between disease presentations were discovered among these three types. The following surgical procedures were performed: Swenson, Soave-Boley, and Lynn. Early complications, which occurred during the first month following surgery, were anastomotic leakage, wound infection, hemorrhage and anastomosis stenosis. Late complications, occurring at least one month after surgery, comprised the following: long-term con-stipation, enterocolitis, incontinence, and obstruction due to adhesion. No significant difference between the complications of these surgical procedures and any accompanying anomalies were found. Most patients had chronic constipation and abdominal distension regardless of the types of involvement, age or clinical presentations. There were few associated anomalies amongst the patients. In some cases, surgical complications were less than those seen in other studies; therefore, it seemed that the performed procedures had fewer complications or may have been performed at the appropriate time

Prevalence of Helicobacter pylori infection among children in Rasht, northern Iran

Helicobacter pylori [H. pylori] infection usually occurs during childhood, especially in developing countries. The aim of this study was to evaluate the prevalence of H. pylori infection among children in primary schools of Rasht, a northern Iranian city. This cross-sectional study was conducted among 961 primary school students in Rasht. Samples were randomly selected and stored at -20°C until analysis. The stool assay was performed using the HP AgT kit. Overall 475 boys and 486 girls, aged 7 to 11 years were evaluated. A total of 384 [40%] children were diagnosed as H. pylori positive by the stool test. A higher prevalence of H. pylori was found in the stools of individuals who consumed well water and municipal tap water when compared to boiled water [p<0.05]. There was no significant difference between the rate of H. pylori infection and individuals' ages, gender or socioeconomic levels. The results of this study suggest that the source of drinking water may play a role in transmission of H. pylori. Transmission can be minimized with the use of boiled or mineral water

Prevalence and characteristics of irritable bowel syndrome [IBS] amongst medical students of Gilan northern province of Iran

Irritable bowel syndrome [IBS] is one of the most prevalent gastrointestinal disorders characterized by non-specific symptoms such as abdominal pain and altered bowel habits with no known organic pathology. Its prevalence varies in different communities. We performed this study to determine the prevalence of IBS in medical students who attended Gilan University of Medical Sciences [GUMS]. Medical students of GUMS were studying during 2002 academic year were enrolled in this cross-sectional study. Within a specifically designed schedule, trained general practitioners performed student interviews. The interviewers used a structured questionnaire based on the Rome II criteria. Data were analyzed using SPSS-10 software. Results were presented as percentages and the mean +/- SD and level of significance was denoted as a p-value <0.05. This study included 422 students, 148 [35.1%] males and 274 [64.9%] females, trained in various educational levels at GUMS whose mean age was 23.7 +/- 2.9 years. The prevalence of IBS was 12.6% [53 of 422]. IBS was more prevalent in females than males [15% [41 of 274] vs. 8.1% [12 of 148]; p<0.05]. Reported a Physician 37.7% of cases visit in comparsion to 17.6% of non IBS case [p<0.05]. This study shows a higher prevalence of IBS in medical students than in other sections of the Iranian population. A prevalence of 12.6% in medical students, who are in an active phase of life, requires careful planning to provide alleviation

Isolation and serotyping of endemic leptospires of west and central regions of the flat areas of Guilan province

Leptospirosis is a zoonosis which is more widespread in the tropical and semi tropical regions, and is endemic in the flat area of Guilan province, north of Iran. Surface waters are sources of saprophytic and carier animals are reservoirs of pathogenic agent. In each endemic region only a limited number of pathogenic serovars are common, and characterization of them is a very important step in detecting the main reservoirs of the disease. This study is performed to isolate endemic leptospires from rice farms, irrigation canals, and rivers of west and central parts of the area, which accounted for a significant annual incidence of the disease. In this cross-sectional study, 500 specimens were taken from 13 cities of the area, between May to September of 2007. One ml of each water sample was inoculated in EMJH liquid medium with 200 micro g/ml 5-flurouracil after filtration by 22 micro m syringe filter. All speciments were incubated in 30°C for 3 months and were checked by darkfield microscope every 2 weeks. All positive samples were characterized by using 30 types antisera. One hundred thirteen of 500 specimens were positive. Saprophytic serogroups were Andamana and Semaranga, belonging to biflexa species. Pathogenic serogroups were icterohaemorrhagiae, pomona, canicola and pyrogenes [interrogans Specie], hardjobovis and sejroea [Borgpeterseni specie], grippotyphosa [Kircshneri]. Pathogenic species were common in the rice paddies and saprophytic species were common in the rice farms, rivers and irrigation canals, respectively. It seems that higher frequency of pathogenic serogroups in rice farms is due to high traffic of animals and rodents, and the long time stay of water in the farms. Isolation of saprophytic serogroups in all types of surface waters was expected. Increasing farmers' knowledge about the ways of the disease transfer, and avoiding of unprotected contact with surface waters might help with decreaseing the incidence of the disease in the area

Pulmonary function test results in patients with ulcerative colitis

Pulmonary complication of IBD includes airway inflammation involving small and large airways, pulmonary paranchymal disease and serositis. The aim of this study was to determine the prevalence of Pulmonary Function Test [PFT] abnormality in ulcerative colitis [UC] patients. During spring and summer of 2006, PFT [spirometry and body box plethysmography] of 50 UC patients were compared with 50 healthy persons matched for age and sex [control]. Data collection form including demographic specification and UC condition were filled. Mean age of patients was 37.2 years [SD=14.5]. Active UC was seen in 24% of patients while 18% of patients suffered from severe UC. PFT results included 42% air trapping [only increase in residual volume/total lung capacity], 20% small airway obstructive pattern [only decrease in maximal expiratory flow at 25-75% of vital capacity], 12% restrictive ventilation defect, 2% obstructive airway, 2% hyperinflation and 6% upper airway obstructive pattern. There was a significant relationship between small airway obstructive pattern and duration of UC and no relationship was noticed between other pulmonary disorders and severity, activity, duration of UC. According to high prevalence of air trapping, small airway disease may be the prominent feature of lung involvement in UC patients. Therefore a meticulous work up for respiratory diseases is necessary in UC patients

immunologic response to anti-hepatitis B vaccination among medical students of Guilan university of medical sciences, Guilan, Iran

An important way to prevent hepatitis B infection is vaccination especially among high-risk populations including healthcare workers. Unfortunately, immunologic response to the vaccine is not perfect. Multiple different factors such as gender, age, body mass index [BMI], smoking and underlying diseases can influence the immunologic response. So, this study was conducted to evaluate the post-vaccination immunologic response of medical students of Guilan University of Medical Sciences [GUMS]. In this cross-sectional study, GUMS medical students who had received complete vaccine series at zero, one, and six months were enrolled. Their demographic data and the factors which could probably alternate the immunologic response were collected by interview. The anti-HBs Ab titer was evaluated by Enzyme-Linked-Immunoassay [ELISA]. Appropriate immunologic response was supposed to be HBsAb >=10 mIU/ml. The collected data were analyzed using SPSS 10.00.P value <0.05 was considered significant. We evaluated 233 students with mean age of 24.9 +/- 4.5 years. 74.7% were female. 4.9% did not respond properly to vaccination. Females' immunologic responses were significantly higher than males' [P=0.001]. Responsiveness was significantly lower in smokers than non-smokers [P=0.02]. Mean age in inappropriate and appropriate responder groups were 28.67 +/- 5.4 and 24.77 +/- 4.4 years, respectively [P=0.004]. 95.1% of students had a protective level of anti-HBsAb [>10 mIU/ml]. Since health-care staffs including medical students are a high risk group to be contaminated with HBV, it is preferable to be evaluated for anti-HBs titer 1-3 months after full three-dose vaccination especially when these factors are present; in this way the false sense of being immunized among them may be decreased

[Clinical manifestations of Hirschsprung's disease: a 6-year course review in Rasht]

Hirschsprung's disease [H.D] is a congenital disease in which intestinal ganglionic cells are absent and can cause intestinal obstruction. The disease has various clinical manifestations and different length of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a 6-year course study in Rasht. The capital city of Gillan province in north of Iran. We studied the Hirschsprung's patients referred to Poursina Referal Hospital between 1995-2001. A cross sectional descriptive- analytic study whose data was collected from patient's files and questionnaires including demographic data, disease presentations, diagnostic methods, involved segment, surgical procedure types, surgical complications. Finally, the data was analyzed in SPSS10 software. We detected 58 H.D in these 6 years, whom underwent surgery. There were 19 females and 39 males. Age of patients differed from one day to 18 year. Clinical findings were variable as follow: constipation [79.31%], abdominal distention [67.24%], inability to pass mecunium [17.24%], diarrhea [5.17%] and other less common manifestations. Pathologically, we divided our patients into 3 kinds: rectosigmoid, ultra short - segment, total - colonic. Surgeries were performed in three ways as follow Swenson - Soave - Lynn. Early complications, which come within one month after operation, contain anastomotic leakage [10.2%], prolonged constipation [10.2%]. There were not any significant differences between these three types of surgical procedures. Majority of patients presented with a chronic course of constipation and abdominal distention. There wasn't any difference between kinds of involvement and age and type of presentations. There are few associated anomalies in our patients. In some cases, surgical complications were less than other studies; so, it is probable that our procedures had fewer complications or they had performed in appropriate time